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Evaluation of Computed Tomography and Ultrasonography for Assessment of Facial Fat in HIV-Infected Patients
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Abstract: H-1953 43rd ICAAC, September, 2003
S. PADILLA, J.A. GALLEGO, F. GUTI…RREZ, M. MASI¡, J.M. RAMOS, C. ESCOLANO, J. PASCUAL, A. MARTÕN-HIDALGO Infectious Diseases Unit, Hospital General Universitario, Elche, Spain.
Background: Facial fat loss is a common and distressing characteristic of the lipodystrophy syndrome in HIV-infected patients. Standardised assessments for this condition are not established and there is a need for quantitative diagnostic tools. The aim of the study is to evaluate computed tomography (CT) scan and sonography to measure facial fat in HIV-infected patients.
Methods: Cross-sectional analysis of 61 HIV-infected patients. Malar fat loss was clinically rated in four steps from absent to severe by a questionnaire. Subcutaneous malar adipose tissue area (SAT) and total malar adipose tissue area (TAT) were measured by CT scan and the SAT/TAT ratio was calculated. Subcutaneous malar fat thickness was assessed by sonography and skin-fold caliper.
Results: All 61 (44 males) patients were on HAART: 41% on NNRTI, 38% on PI and 21% on NNRTI plus PI-based regimens. Median (range) exposure to antiretroviral therapy was 48 (132) months. Lipodystrophy was present in 31 (51%) subjects (peripheral lipoatrophy 19, mixed syndrome 7, central obesity 5 cases). Malar fat was clinically assessed as normal in 39 (64%). Mean values of CT and skin-fold parameters in patients with absent, mild, and moderate-to-severe malar fat loss, were as follows: SAT, 4.12 vs 2.74 vs 0.74 cm2, p <0.01; SAT/TAT ratio, 0.18 vs 0.13 vs 0.11, p <0.01; and malar skin-fold, 12.52 vs 10.56 vs 8.25 mm; p <0.01. Skin-fold measurements were positively correlated with SAT (r=0.58; p<0.01) and SAT/TAT ratio (r=0.34; p=0.031). No significant difference was found in subcutaneous malar fat thickness assessed by sonography. An SAT < 2.34 cm2 and an SAT/TAT ratio < 0.10 had a sensitivity of 71% and 74%, and a specificity of 71% and 67%, respectively, to diagnose malar fat loss.
Conclusions: Computed tomography may be a useful technique to quantify facial fat in HIV-infected patients. Our results do not support a role for ultrasound measurement of malar fat.
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